Calcitriol in CKD — RACP Adult Medicine MCQ

Correct answer: D — Correct modifiable factors including vitamin D deficiency, hyperphosphataemia and hypocalcaemia, then reassess the parathyroid hormone trend

The best answer is “Correct modifiable factors including vitamin D deficiency, hyperphosphataemia and hypocalcaemia, then reassess the parathyroid hormone trend”. In non-dialysis CKD, an elevated or rising PTH prompts evaluation of modifiable drivers such as phosphate excess, hypocalcaemia and native vitamin D deficiency. Calcitriol is not used routinely and is generally reserved for severe, progressive secondary hyperparathyroidism after these factors are addressed because it can worsen hypercalcaemia or hyperphosphataemia. Surgery and calcimimetic therapy are not first responses to this untreated biochemical pattern.

Reference: Kidney Health Australia: CKD Management in Primary Care, 5th edition: https://kidney.org.au/health-professionals/ckd-management-handbook/